Enabling Health Reform in Odisha, India: The Role of Applied Political Analysis
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Campos R., Paola Abril
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Campos R., Paola Abril. 2020. Enabling Health Reform in Odisha, India: The Role of Applied Political Analysis. Doctoral dissertation, Harvard T.H. Chan School of Public Health.Abstract
Creating large-scale health system change requires a combination of technical solutions and political skills, analysis, and strategies. Understanding the political context of health reform is crucial to improving the chances of effectively designing, adopting, and implementing health policies that can achieve their intended objectives. Applied political analysis has been used to support health reform in diverse national contexts in low- and middle-income countries for different purposes. However, there are few published accounts of the process of conducting applied political analyses, let alone evaluations of the outcomes of political strategies. This gap in the literature hampers the development of the field of applied political analysis for health reform. A proper understanding of what works and what does not in doing applied political analysis is required to support health reform processes.This DELTA thesis examines the process of conducting an applied political analysis to inform the development of policy proposals to improve the performance of the health system in Odisha, India. An applied political analysis of the position, power and interest of the stakeholders involved in health policy changes helps to understand their role in promoting, resisting, or blocking implementation, and the dynamics of their interactions (Reich, 2002). I followed the Six Steps for Applied Political Analysis (Reich & Campos, 2019): 1) Define the audience (client) and the problem; 2) Identify the policy to promote; 3) Describe the context of the policy; 4) Conduct a stakeholder analysis; 5) Design a set of political strategies; and 6) Assess the impacts of your political strategies. A purposive sample of stakeholders was selected to represent five different groups in the health policy ecosystem in Odisha: interest groups, bureaucrats, financial decision-makers, leaders, and beneficiaries (Campos & Reich, 2019).
Applied political analysis does not guarantee success in policy reform or implementation. Policy processes are often unpredictable, and the context may change from one day to the next. However, being prepared to manage the political dimensions of health policy processes can increase the likelihood that the changes will be adopted and will achieve the desired outcomes. The role of applied political analysis is to help reformers engage effectively with the political context to create political feasibility for health reform. I offer four key lessons on how to improve the process of conducting a stakeholder analysis: 1) Purpose and framing: having a clear purpose for the analysis, a clear problem, and an engaged audience; 2) Timing: harmonized timelines and workplans of the technical and political analyses teams are needed; 3) Organizational context: a team of internal and external analysts, and regular communication with the client are essential; 4) Methods: the choice of the methods will depend on the purpose of the analysis and on the resources available to conduct it. Repeating the analysis over time as the policy process unfolds, and keeping track of stakeholders and strategies, can increase the chances of successful reform.
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